MEDICARE: GISELLE PHELPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285334250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GISELLE PHELPS

Provider Business Mailing Address
First Line	:	170 GREGORY LN
Second Line	:
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-2177
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1909 HILLBROOKE TRL
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32311-7901
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2023
Last Update Date	:	03/07/2023

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Directions to “ GISELLE PHELPS ” Practice Location

Language	Start Address	Practice Location

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